Policies & Procedures
What is the title of MCD122?
Fraud and Abuse Indicators
A parent is calling to obtain information about their underage child's OHP plan. Do we need to obtain verbal authorization before we can release PHI?
Moda makes exceptions for Subscribers who are minor children on Individual and OHP Plans. If the parent calling in can authenticate the Subscriber, it is okay to release PHI.
Is P00001290918 INN with our Medicaid plan?
Yes
Use ID CO88546C
What note does Benefit Tracker have regarding acupuncture benefits for a non-back/spine diagnosis?
Non-back/spine diagnosis, Acupuncture and Chiropractic: OHSU Health requires prior authorization and medical necessity review for all visits.
Which click notes are selected for eligibility?
Eligible
Effective Date
Plan Description
Class Description
What is the title of MCD7?
Interpreter Services for Non-English Speaking Members
A member is calling to obtain information about their own plan. They provide their name and DOB, but they do not know their ID number. What other information can we obtain from them to validate their account?
1) SSN
or
2) Address
What is the NPI for P00001580613?
1659831386
Use ID CO88546C
Under which category would you find "Wheelchair?"
Professional Services, DME, & Supplies
What is the subject/category for a call where we helped find an INN provider for a member.
Provider
Search: is provider in network / Search: other
What is the P&P reference number for Tobacco Cessation for an EOCCO member?
MCD126
A healthcare provider wants to know who their patients PCP is. Can we provide that information?
Yes, we can provide that information to the healthcare provider.
How many practitioners practice at Provider Group P00001300404?
Two
Use ID YC800M0J
Is this member eligible for glasses?
No. Members are only eligible for vision hardware if they are under 21 or pregnant.
Where can an EOCCO provider find the sterilization consent form?
I'm a Provider > Resources > Forms > Sterilization Consent
What is the P&P reference number for selecting a PCP for an EOCCO member?
MCD8
What do we need to receive in order to establish a Power of Attorney for a member?
What Provider Group does P00001356994 belong to?
Harney District Hospital
Use ID YC800M0J
Is this member eligible for an eye exam?
Yes, Benefit Tracker shows there is 1 remaining vision exam available.
A provider is calling, where do you document their NPI or Tax ID in Facets?
Under SSN/ID
When was the most recent revision for MED1181 published?
03/19/2025
True or False:
A members Agent of Record can request a change of address for a member.
True
Search the Practitioner application for Stephen Haltom who practices at 2500 NW Neff Road, Bend, OR 97701.
When did this provider become active with our Medicaid network?
01/20/2022
Use ID AV11146B
How many days does this member's plan cover at a Skilled Nursing Facility?
The Plan covers a 20 Day Maximum of skilled nursing care.
What is the subject/category for a call inquiring about coverage for a vision exam.
Vision Benefits
Exam